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T11N R3W SEC 1 N2NE4NE4NE4
Onsite File T11N R3W Section 1 N2NE4 NE4NE4 #020-521-10 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page j of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: Sw Lr)3 C) 1 &0 PID Number: 0� ©�i'� - 0 ` Name: Wastewater System: [New ❑ Upgrade Address: C; ,— f e- ABSORPTION FIELD Phone: Number of Bedrooms: ❑t /r Deep Trench ❑Shallow Trench ❑Bed 'Mound ❑Other. Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION 2/7 GPD/Fl" Q Fl. Block: Lot: Subdivision: ( \'LfN t 19 Depth to pipe bottom from original grade: Gravel depth beneath pipe: 0, `.,i+ I J e 1 ^ DJ _; Ft. Fl. Township: Range: Section: Fill added above original grade: Gravel Length: 1 1� 2 • 'J Ft. v Ft. Well: New ❑ Upgrade Gravel width: L) Number of Imes: Distance between lines: 1 5 i Fl. 02 FL Classification (Private, A, B, C): -P 17 I V T-E Total Depth: ) ;?--7Fl. Cased to: b > Fl. Total absorption area: n Fe Pipe Material: p j i - Driller. { /�L�.t�t- Date Drilled: to-X3_0-13 Sialic Water Level: �� FL Installer. Dale Installed: Yield: f Pump Set at: Casing Height Above Ground: TANK ,�2U GPM 'FCiTTONI Ft. 2, Fl. SEPARATION DISTANCES �� El Septic El Holding ElS.T.E.P. 19 Other: To Septic Absorption Lift Holding Public/PrivateManufacturer. Capacity: From Tank Field Station Tank Sewer Line j?, i Jt:' C Li^ J&V0 Gal. Well Material: Number of Compapartments: / Surface Water ;�-v I t I�,v -r LIFT STATION Size: Manufacturer. Lot Line i oz C 1r t f �'V 1 &0 0 Gal. 13 / J c'( C L- L 'Pump on' level at: 'Pump off' level at: High water alarm at: Foundation l�� tp •� �� in. %� in. in. Drain (� J VCurtain Pump Make & Model 7 tL Electrical Inspections performed by: I �_% V N 3 Remarks: BENCH MARK Location and Description: AvL'Po2i S NI Se_;17 00 TO" Si1D11-lh Assumed Elevation: Fora F u: T iza S/ M17 Coam a iv0 Fl. cop ©% , Dates: 15' ID - 1-O 3 Inspections performed by: 7.5 2nd j !) - 3 1 ' D 3 m.�mo®®, oq® 000tawoa Development,,$e,rvices Department Approval Reviewed and approved : % CLDate: PP b Y'�,s� (Rev. 12/00) KING£ WAY ~DRIVE TOBBEN SPURKLAND P.E. 203 P/ 15TFI. AVENUE ANCH. AK. 99501 (~0~) IDAN/EL HALL 15610 KINGS WAY SEPTIC SYSTEM AS BUILT DATE: MARCtl 15, 2004 SHEET: 2/3 GRID: 2630 PERMIT #2V030160 PID # 0~-033-0~ II3OlHALL£.~DWG /- 6RADE TD I~AIX I' t=: ~,~~ ~ ~- . ? ~~=~ ~'~vc '. "'. ' '. ' ':' :~ '~ '~." ~"- ' ' ~ _ ~1 I~ATI~ ~ . ...~~ A.~.... -..:.. I STAN~A~ ~ED J ~, ~ T~ L~I~ ]N~ TALLA ~T ~ ~ ~ ~L 9/~CT~ ~; ~ ;:. .. ,o TOEEEN SPURK~MD P.E. ~/~,~1/~,~/~,~]/~,~C.], ~11~ ~3~ SEPTIC SYSTE~ ~HE~ATIC 203 W 15~. A VENUE DAN/EL HA~ DA TE: ~ARCH 15, 2004 ANCH. 99501 P,O1 Mummpal ty of Anchorage iDepartment of Health and Human Services 825 "L" Street 'P.O. Box 196650 Anchorage, Alaska 99519-6650 Rick Idystrom ~: t~t:3:l/www.cLanchorage.ak.us Mayo~ ; Permit Number: #$,~,r 030160 ])ate of Issue: 5-28.03 Parcel Identification Numb¢ ~:.020-033~O2. Date Started: 10-23-(~- Date Completed: ~0-23-03 Is w~ll located at approvcd~crmit I~cation? [] Yes [2 No Leg~a oeseripdo,,: ; T11N R3WSectk)n Den Haft : 8101 Fairwood Circ/e ' ~ & Address: Fropert7 Owner Nam! Borehole Data: Soil Type, ThJc$m¢:~ & W~ Anchor~ A Depth (ft) From To 0 2 2 4 4 7 7 32 32 38 38 43 43 63 63 66 66 127 94 12T sticg-up ; Bra vel fill organ/cs and stTt gravelly sift sandy silty gravel H20 gravelly s~ silty water send & gravel 50 gpm clear-appears to be high iron ,3edrock ~9518 ~ I Casing type: areal W~ ~c~ess: Liner ~e: ~ D[~eter: mc~s Dcp~x: , feet Ca~g s~ckup a~v~ ~u.d: ~ fe~t~ Pump~g I~ei:,..12~.~cet ~ ho~ p~ping 2q~m Method of T~g: fly I~ · Weg In~c Opcn~g Type: ~ ~cn End ~ 9pcn Hole ~~ S~~ f*~ StoOd, , feet ~ P~ormi~ S~~ fe~ Sto~ed, f~et ~p~: t S~ ~ feet i; Stopped ? f~t ~mp: ~lake ~ept~ ~p ~e Wall Dis~f~ted U~n Complefion~ ~ Y~ ~ No M~hod of D~infec~on: Comm~n~: Well Dflllen Alpi~ DHIIi~ & Ente&~s ~ Bbx 110496 A~?ra~ Alaska 99~1 H20 Att~atiom The wel:l driller shall ixovide e veil log to the property,,,..,,,owner,, ,,within ...... ~ da;~s:., ofcomplction,.,. -.,. ,-,, , .... andi thc.property..,.... TOTPL P. 01 !5 04 RSG 907287514~ II MUNICIPALITY OF ANCHORAGE Developrnent Services Department On. Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: May 28, 2003 Expiration Date: May 27, 2004 Permit Number:[ SW030~60 '! Legal Description:~:TllN R3W Section 11 N2 NE4 NE4 NE4 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Ron Hall Owner Address: 8101 Fairwood Cir Anchorage, AK 99518- Parcel iD: 020-033-02 Site Address: 8101 Fairwood Cir Lot Size: 217800 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [~ Disposal Field ~-~ Septic Tank ~-~ Holding Tank [~ Priw [] Private Well ~'~ Water Storage All construction must be in accordance with: 1. The attached approVed design, of Alaska e ents s ecified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State 2. All requir ~ , P , - ........ ~-~,~ ~ ,~,H nrlnt~inn ater Re ulations ( 18AAC80 ). Wastewater Disposal Regulations ~, '~ o/-w,----- ~ o ............ ~ W g 3.The engineer must 'notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-790z~ ( 24' hours ). ( Not required for a Water Supply Permit only ). 4.From October i5 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. ~5.- The follOwing special provisions. ~ ' '~THE SAND USED IN THE FILTER LAyERMUST BE A cLEAN COARSE SAND WITH 4% OR LESSpASSING THE' ~#100 SIEVE AND 2% OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON THE ~ sAND USED OR OBTAINED FROM AN APPROVED SOURCE. ~ ~,ceived By: ~ued By: ... Municipality-of!Anchorage DeveloPment Services l Depa'rtme'nt ' . :': i'. BUil~iin'~ s~fety'Di~,'ision" :" '."' '"". on-site water and Waste~a.t~.'Program ' ' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650'. www,ci.anchorage:ak.us (907) 343-7904 ON-SITE'SEWER~ELL PERMIT APPLICATION FOR A SINGLE 'FAMILY' DWELLING Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) . Lot Size -,~ Acre~ 2-17 THIS APPLICATION IS FOR:' Sewer Only Sewer and Well Sewer Upgrade I--i THIS PROPERTY CONTAINS: Hot Tub [-'l Swimming Pool Therapy Pool r-I Permit Number SWO,,,3OJ' 60 Day phone ~ ~L,~ -- t q'3 I~, Number of Bedrooms Zip Code C,~C~ ~'\ ,J Well Only. D Water· Storage ['-I Jacuzzi [] Water Softening Unit [] I certify that the above information is correct. I fudher certify that this application is being made for a Single Family Dwelling and is in accordance with applicable MunicilSal Codes. (Signature of property owner or auth~{rized agent) i' .'~ ~ :.. Permit Fees: -~ ~ ~ ~ Waiver FeeS: Date of Payment:. Receipt Number: ' (Rev. 12/00) Date of Payment: ReceiPt Numl3er: 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN Nll2,NEII4,NEll4,NEll4, SEC. 1, TllN, R3W Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 May12,2003 We are submitting an application for the installation of a well and septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: Groundwater at 6 Ft. Use Standard Bed with BioCycle Soil Rating. From Testhole 11/05/02 6 rain/in = 3 gal per sq.tVday No. of Bedrooms 4 Required Area per Bedroom: 150/3 = 50 sq.fl. Total area required: 50 x 4 = 200 sqf~ Bottom Rock At existing Ground Level Filter Sand 2 f~ Top Rock At 0.5 feet ~ Rock Depth 0.5 feet Total Bed Length 200 /10 = 20 USE20FT SYSTEM CONFIGURATION BIOCYCLE STANDARD BED TOTAL LENGTH 20 FT TOTAL WIDTH 10 FT TOTAL DEPTH 2 FT FILTER SAND 2 FT ROCK DEPTH 0.5 FT COVER 3 FT The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface rtmoffwill not result from this installation. 33' S£¢TION 1 I I I ~ I I II i TOBBEN SPURK~NO P.E. N1/2,~1/4,~1/4,~I/4, ~EC.l ~I~ 203 · 15TH. AVENUE RON HA~ DATE: MAY I2, 2003 ANCH. AK. 99501 15610 KINGS ~AY SHE~: 1/3 GRID: 2630 PERmiT ~ SVO30~X P]~ ~ X~ L--4 _1 II i ~-~ ~'~_. ~ ........ ~ P-~ I' ,.¢%~...: .... --.?;.._~,, _ :' 49't;h ~-~ ~_ ..... :~ i~......; .... m,"~ II ..{ y. ~. ....... L.........~...- I · , t '%1.o ........... ~, ~' 2~' 0 ~ ~ 7~ 100 1~-~ 1.50 SCALD 1' = .50 FT. I'OBEEN SPURKL41VO P.E. NI/2,1~I/4,NL~I/4,1~I/4, 20S W lSrl. I. AI/£1qUE RON HALL ~ATE: t. IAY 12, 200S AN~Iq. AK. ~501 I$$I0 KIN~S WA}' SHEET: 2/$ C, RI~: 2~$0 (~oz) 27~-a~ PERt. tIT #$VO3OXXX PlO tt XX II301H,4LL,2.BVa FI1U~ TI~ CLEAN OUT A$1'M 3034 ~ SLOPE FINI£/'/ED GRA~ AVAY I STANDARD BED ] 1~ ~ /,.~TTOM DF TANK · ~-u ' %,,.4' SAN~/GRAW'L LEVELING COURSE, COMPACTED INS TALLA TI£N 1. EXCAVATE A 10' x I0' x I0' DEEP HOlE ['~ ,~IOCYCLE SYSIE~ ,2. PLACE A MINIt~ Of' 4' ~ l~? GRAVEL r'lR LEVt'7.DVG gZ~IRSE IN THE BOTII~ OF THE EXCAVATIOi~ COMPACT AS ~ PLACE 4 SttEETS Of' B' x 8' x B* DIRECT BI. RIAL RIGID INSULATION ON TOP Of' gZlviPACT£D LEVELIt~G COURSE TO Pt?OTECT BOTTOM OF FIZ~RGLASS TANK, TAKE E~I'RA CARE TO ASSU~ THAT INSULATIZIN CDLRS£ IS LEVEL IN ALL 4. BACI~LL AR/lIND TAI~ UP TO INVERT OF 4' .~t~ AI~ I-1/4' ED-LUENT LIltS I/ITH r"~-'f'LOVIl~G NSF #ATERIAL FREE OF LARG~ rOSBEN SPI. I£KLAND P.E. Ni/£,.IV~I/4,.IV~I/4,NEI/4,$E¢.i, rllff, l?a SEPTIC SYSrEW S /EUAT/¢ 205 PI ISTH. AVENUE RON /-/ALL DATE: WAY 12, 2005 .4NCH. AK. 99501 15~I0 KINGS WAY SHEET: $/$ GRID: $241 (907) 279-$916 PERt,lIT # SP/O3§OXX PIB # XX II3011-1ALL3,gP/G Performed For: Legal Description: 3- 4- 5- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- ¢1,,7, COMMENTS Municipality of Anchorage Development Services Department Building Safety Division On. Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 1S6650 Anchorage, AX S9519-6650 www.ci.anchcraqe.ak.us (907) 343-79~)4 Soils Log - Percolation Test "12. o N Date Pedon'ned: ~. t I ~ [ 0 'Z,., NIE'-'lH.T°wnship'Range'Sec~°n: 'T"il l',J., ~'~ ~'~ 5 l~-.~ I Slope Site Plan WAS GROUND WATER E,',:COU?ITERED? IF YES, AT WHAT DEPTH? Depth to Water A~ter Monitoring? s £ Reading Date I GrossTime I NetTime I Depth to Water [ NetDrcp · l"'p,e I I FERC HOLE DIA,'..IETER ~ FERCOLAT OH PATE PERFORMED IN ACCORDANCE WITH ALL STATE AND ,MUH;CIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '~--~7./D '~.. ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE ANI) garleanna Soto THIs MEMORAND~ OF UNDERSTANDING made and entered into as of this day of May 2003_~_, by and between Marleanna "OWNER," and the Municipality of Anchorage, herein the consideration of the mutual covenants contained herein, the parties to this Memorandum of 28th soto-- ., herein the "MUNICIPALITY." In Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEM~. Municipality grants permission to Owner to utilize and operate an Advanced wastewater Treatment System located at TiiN R31d c~..C~..[ , (AWWTS), described as Biocycle Anchorage, Alaska. Definitions. A. Alteration. Any change to the desi~ or function of an AWWTS that o o includes the installation or removal of any parts, components or pieces not incIuded in the original construction permit and design. Prior to performing any alterations to an A~,VWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65 Certificate of On-Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal svstems given at the time of property sale and title transfer in accordance with AMC Page 1 of 5 15.65. These approvals i certify that the systems are adeqUate for the homes that they support and meet the codes that were in place at the time of system construction. c. Damage. Any man-made or natural change.in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to Eo .perform as designed. Permit (Construction). An On-Site'Wastewater Disposal System ';" 3 ,,.- Construction Permit as defined by AMC 15.65. F. Permit (Operating). An Advanced Wastewater Treatment .System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AW~VTS, upon.meeting all requirements of this a~eement, the conditions of the. Operating Permit, the requirements of the On-Site Wastewater:System Construction Permit and all relevant provisions of.~MC 15.65. 3. ~Fee, :' :O,;vfier shall pay t° Municipali.ty an annual fee of $o (S o.00), payable on or before the issuance of the operating permit and annually thereafter. The annual tee is due on.or before the. a. nniversary, date of the approval by the Municipality of installed system. Page 2 of 5 4. Term. 'The term of this' Memorandum of UnderStanding shall be for the life of the AWWTS. The term begins on the date of approval by the MUnicipality of the installed system and shall' continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of on site approval is issued to the new owner or transferee of the property. 5. Alterations, Installation' and RemoVal of Additional Equipment..Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction permit. froTM the MuniciPality. 6. Maintenance and Repairs. : 2. ThroughOut the term of this Memorandum .of Understanding, the Owner shall maintain AWWTS in good repair.' ~In addition, it shall be the responsibility of.the Owner during'the term of this Memorandum of UnderStanding, and any extensions or renewals thereof,: at"the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement Costs, and (5) inspection costs. Further, owner agrees to comply with all'appliCable ordinances, laws, regulations, rules and orders for the AV~VTS. B. 'Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions Contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the. Municipality annually upon the renewal of the permit. The schedule.of maintenance and repair contained in the Owner.'s AWWTS Operating Permit is: Page 3 of 5 :,Owner'acknowledgeS that the fine schedule for failing to maintain and repair an AWWTS are 'codified in AMC 14.60.'" D..' oWner agrees'~ that only maintenance, repair personnel certi'fied by the Municipality will' inspect, and make .any alterations to the systems. necessary-maintenance, rep,airs, or permitted E. · Owner a~ees to.gran[ the Municipality reasonable access AWWTS upon 24 hoursWritten notice.- . to test and inspect the F. Owner a~ees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. · G.' Owner a~ees that the relevant provisions of~ the Standard specification guidebook'for AWWTS'is the governing profess!onal guid. elines maintenance and repair of the Owner's AWWTS. for the'. cofistmcti0n, 7. Nonwaiver. The failure of either party.at any time to enforce a Provision'°f.this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way affect the' validiLy of this Memorandum of Understanding or'any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. ~ Amendment. A.' This,Memorandum of Understanding shall only be amended, modified or changed bv a writing, executed by authorized representatives of the parties, with the same formalitv as this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. Page 4 of 5 For the purposes of any amendment modification or change to the terms and conditions of this contract, the onlY authorized representatives of the parties are: Owner: Marleanna Soto ' .',< ,.',' Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern, the rights and obligations of the partie.s under this Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: MUNICIPALITY: By:. '~ ~ X-r~¢" ~'cr~, By: Title: Date: ~xa_ ~[ ,~l~vB Date: STATE OF ALASKA ) .. ) SS. " THIRD JUDICIAL DISTRICT ) me this~/day of ~ , 200'~, The foregoing instrument was acknowledged before of~//%~'-~~n be~atf of' by ~tunicipality ~hora~_e. NO, KY POBEIC F~~KA Page 5 of 5 ~\\~% I IIII////_ .c ~-- ~ 4., ,,.~ _ M5, Commission exPires: · '-,-,* ~' I '-5 ,-,~ .?? ..... ////llllltl~ Eichard~SSIGNMEN~AACodc Addendum AMC i 5.55 ~00-0257]~cmo~nudm of Und~mtandin8 Vcmion Vi.doc Page 6 of 5 Tobben Spurkland P.E. 8155 Cranberry St. Anchorage, Alaska 99502 P. hone (907! 243-5302 '~/2__o7 F. Robert Bell & Associates 3340 Arctic Blvd. Anchorage, AK 99503 Attention: Jim Reilly Subject: Soil Investigation, Lions Park Subdivision Gentlemen: Per your request, we conducted a propesed Lions Park Subdivision during 1982. soil investigation in the the week of 11 January, The work consisted of digging a test pit on each of the proposed lots in the subdivision. The test hole locations were staked by you, and the general location is indicated on the attached soil logs. Since there were no visible corner stakes, we had no way of verifying the staked locations. The work w.as accomplished using an MF-70 tiremounted backhoe. In general, the soils found are not suitable for on-site sewer disposal systems. The soils are very poor draining, evidenced both by the surface water showing up in the tire tracks and also by the smell of the peat, a musky swamp odor. The peat layer is thick, consisting of partly decomposed organic matter. Though no percolation tests were conducted, I will estimate that the percolation of the clayey material is in excess of 350. The Municipal Code states that any soil with a rating higher than 330 is unsuitable for on-site sewer disposal. Groundwater was encountered in two of the test holes. A four-foot separation is required between high ground water table and the bottom af any proposed disposal system. That require- ment will preclude systems on Lots 4 and 5, where the soils were more granular than on the other lots. The surface water may also present a problem in developing this property. Extensive ditching may be required to control the water. $ 0 7 0 $1002 Tobben Spurkland P.E. 18 January 1982 F. Robert Bell & Associates Page 3 '" If I can be of any more assistance to you, please contact me. TS/cls PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SO LS LOG -- PERCOLATION TEST SLOPE c /sc J 9- 10- 11 12 13- 14; 18- 20- DATE PERFORMED: SITE PLAN ~J~ SOILS LOG [] PERCOLATION TEST O p IF YES, AT;WHAT ~ DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND .(minutes/inch) FT COMMENTS PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20- COMMENTS SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS L.OG -PER. COLATION TEST SLORE II DATE PERFORMED: SITE PLAN [] PERCOLATION TEST ' ASGROUNDWATER kJ E ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND minutes/inch) -- FT PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6- 7 8 9 10 11 12 13 14- 15- 16- 17- 18- 19- 20 COMMENTS SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 "SOILS LOG- PERCOLATION TEST [] PERCOLATION TEST LoT ,~, LIONS cf CH ~l~.l~, e.~DATE PERFORMED: SLOPE SITE PLAN I' Lo~ ~ LOT~ 2225-E JUNE 25, 1971 WASGROUND WATER KI S ENCOUNTERED? ~ O ~ P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BE~VEEN FT AND FT PERFORMED BY:~ CERTIFIED BY: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION IJ25 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST LEGAL DESCRIPTION, L~-~ , 1 8 WAS GROUND WATER 1 1 ENCOUNTERED? 12 IF YES, DEPTH? 13 DATE PERFORMED: SLOPE P SITE PLAN Gross Reading Net Depth to Net Time Water Drop 2225-E 25. ].971 17 18 19 20- PERCOLATION RATE TEST RUN BETWEEN , FT AND (minutes/inch) FT COMMENTS PERFORMED BY: ~--~ ~ CERTIFIED BY: "~ ~ATE: 1!1~-/~1 C SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST [] PERCOLAT[ON TEST ! LEGAL D E SC R I PTI O N :~J~,~ ~l' ~. 8 SLOPE DATE PERFORMED: II IE I~.~- SITE PLAN TH ~cT ~_ Lo'1 S 10- 11 13- 14- 15- 16- 17- 18- 19- 20~ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ~-~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: CERTIFIED BY: Parcel I.D.— 020-521-10 .GE E4 Municipality of Anchorage On -Site Water and Wastewater Program . (907) 343-7904 s F E 7 Y Certificate of On -Site Systems Approval on Date: V Expirat8e-o+8 1. GENERAL INFORMATION: Complete legal description T11N, R3W, SEC 1, N2NE4NE4NE4 Location (site address) 15610 Kingsway Drive - Anchorage, Alaska 99516 Current Property owner(s) Daniel Hall Day phone 444-4041 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual F� Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5501 1 ! �. 6c) Date of, Payment 5 a 7 ao. 6 Receipt Number 5J 3 G COSA # 68C2.01213 Waiver Fee $ Date of Payment Receipt Number Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group; Ltd (GEG) Phone: 907-337-6179 Address: _3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 6/8/2020 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the �� QF evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells O: 'T•• vLC� and septic systems depend upon a variety of variables, including but not limited to, soil conditions,` JI L! \ : groundwater levels (that may fluctuate during the year), quality of construction (materials and % u TF 7 workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and l'"""' "' """' """"' are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of • • the well or septic system. GEG makes no representation whether an alternative well or septic system f/v r ey "' • Gorr ass_ can be installed on the property in the event either of the current systems fail to perform adequately in Q'1 CE -79 , the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or p f ' & party (including subsequent property purchasers) is not authorized, nor will it confer any legal right �1 ��ress',00 whatsoever. 6. DSDSIGNA T URE / W System #1 Approved for V/ System #2 Approved for Disapproved Conditional approval for M #AECC884 bedrooms of�%-�_ �� bedrooms �` 01 S p,ND y bedrooms, with the following sti tion�IP1\41\1N ER o p�gS QPM N� o -N Original Certificate Date: Jun, 0 Q o o o The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Atl'vi5ory Arsentc°Ac3.yisor,-y, Other 4 "` COSA Checklist Legal Description: T11N, R3W; SECTION 1 N2NE4NE4NE4 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 10/23/03 Total depth 127 ft Cased to 68 ft ❑ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/4/20 Static water level at beginning of test 11.9 ft. Comments B. TANK DATA Age of tank(s) 17 years Tank type/material BIOCYCLE Measured operating fluid level in septic tank N/A FE1 Standpipes/foundation cleanout per record drawing Date of pumping SEE ATTACHED MAINTENANCE INSPECTION D. ABSORPTION FIELD DATA Which system tested (date installed) 10/31/03 ❑■ ALL standpipes present per record drawing Total measured depth from grade 3.5+ ft (max) Measured depth to pipe invert from grade ft (min) ❑■ N/A — pressurized field ■❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Q.E.ri sin Parcel ID: 020-521-10 Structure served by this system 1 Well production at time of test 7+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate 2.85 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 5/4/20 C. LIFT STATION ❑■ Required maintenance completed Age of lift station 17 years Lift station material BIOCYCLE Comments: N/A Adequacy test date 5/4/20 Results [DPass For 4 bedrooms Fluid depth prior to test 0 in Water added 639 gal New depth 4 in Elapsed time 120 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' F✓ Yes if No Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft [z Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' 2 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No Q✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft R] Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0✓ Yes if No ft Surface Water > 100' ft ft ft ft ft Q✓ Yes if No ft Property Line > 5' F✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100'✓❑ Yes if No Water Main > 10'✓❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No. Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' QQ Yes if No Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS PER OWNER, WATER SERVICE IN SHOP - SEWER SERVICE IN SHOP GOES THROUGH HOME. *KEYBOX IN FRONT OF HOME - UNKNOWN WHERE WATER LINE ENTERS HOME. G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet // 5 G0" Fo #AECC884 ft ft ft ft 3705 Arctic Blvd #313 Anchorage AK 99503 [Ir.,�,01hi 4EC)�E-Alaska Email: crbioak@gmail.com (907) 274-0314 Homeowner Info Customer Name: Dan Hall Tank#: 157 Install Date: Oct. 2003 Address: 15610 Kingsway Drive Area: Bear Valley Alarms Tested: Air 171 High Water 0 Battery Tested: Yes [:] No F-1 N/A (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No Will Yes F-] (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes 0 Repaired ❑ Yes 0 Repaired E] Strong E] Mild F-1 None Z System Inspection NNUMEN Ell 1 Ell Inlet plumbing in working order? Yes 0 Replaced El Are all aerators functioning? Yes 0 Replaced D Solids pillow normal? Yes 0 Requires Pumping 0 Any buildup of solids? Yes F-1 No 0 Filter cleaned? Discharge line condition: Yes 0 N/A ❑ Good Z Replaced ❑ Comments: Inspected By: Chris/Abi Date: 03/09/2020 Has emailing or mailing of form been requested? (contact office to request...) Yes No F� F, 3705 Arctic Blvd #313 Anchorage AK 99503 Alaska Email: crbioak@gmail.com (907) 274-0314 2ndQuarter Inspection Report 2019 Lk Homeowner Info Customer Name: Dan Hall Tank#: 157 Install Date: Oct. 2003 Address: 15610 Kingsway Drive Area Bear Valley Alarms Tested: Air 0 High Water 0 Battery Tested: Yes F-] No F-1 N/A (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No g Yes R (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes 171 Repaired ❑ Yes 0 Repaired F-] StrongF-]Mild F-] None 0 Filter cleaned? Yes 0 N/A F-] Comments: Discharge line condition: Good Z Replaced Has ernailing or marling of form been requested? inspected By: Chris/Abi Date: 06/25/2019 (contact office to request...) Yes F-1 No 3705 Arctic Blvd #313 Anchorage AK 99503 D E -Alaska Email; crbioak@gmail.com (907) 274-0314 3rd Quarter Inspection Report 2013 %A Homeowner Info Customer Name: Dan Hall Tank#: 157 Install Date: Oct. 2003 Address: 15610 Kingsway Drive Area: Bear Valley Initial Inspection: Alarms Tested: Air 0 High Water 171 Battery Tested: Yes F] No R N/A (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No 0 YesE] (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes 0 Repaired D Yes 0 Repaired F-] StrangF-1MildE] None 0 System Inspecdon Inlet plumbing in working order? Solids pillow normal? Yes 0 Replaced E-1 Yes 0 Requires Pumping E-1 pH Reading: Dissolved Oxygen PPM Turbidity of discharge (in FTU) (pH of 6-8 is ideal) (2-5 is ideal) (Under 35 FTU is considered compliant.) Filter cleaned? Yes 0 N/A ❑ Comments: Discharge line condition: Good Z Replaced F-] Inspected By: Chris Date: 9/24/2019 Has emalling or mailing of form been requested? —1 (contact office to request...) Yes No 3705 Arctic Blvd #313 ~��M�� AK 99503 ~�w�~���~".~..^°^^`^~t��.���~~'. EzouU:cchinak@0zoud.cncu (907) 274-0314 ��th Quarter Inspection Report 2019 Homeowner Info Customer Name: Dan Hall ]Quzb#\ 157 Install Date: Oct. 2003 Address: 15610 Kingsway Drive Area: Bear Valley Alarms Tested: Air 71 High Water 0 Battery Tested: Yes F -I No F—1 N/A r� (Please make sure alarm imon"nmnna|"' not "mute") Does system have a septic tank ? No 0 Yes 0 (Recommend pumping tank every 2 years) |sSystem Lid Locked? Lid hardware inworking order? bthere any noticeable odor? Yes 0 Repaired Yes 0 Repaired R Strong R MiNE] None Inlet plumbing in working order? Yes 0 Replaced E-1 Are all aerators functioning? Yes 0 Replaced El Clarification return system operating? Yes 0 Adjusted F� pH Reading: System Inspecdon Dissolved Oxygen PPM Solids pillow normal? Yes 171 Requires Pumping E-1 Any buildup ofsolids? Yes FJ No 0 Any buildup ofsolids? Yes R No 0 Turbidity ofdischarge (in FTU) (Under 35FTU mconsidered mmpliant.) Filter cleaned? Discharge line condition: yesr�i N/A F—} Good [�� Replaced F—} + + AL+ HOME SERVICES INC. �,501 E. 1'� Oth Avenue Alaska 99516, -345- 1,, 90 CUSTOMER INVOICE# Slock 0. DATE if DE -S - CRI PTION AMOUNT 0 5>.. 210 22 10 Repaired pipes �r engineers specffica6ons @ 156110 Kj-qs �Aky ofive �N r Gallons Septic Leach Area Holding Tank PROBLEM AREA — CALL FOR MORE INFORMATION NEEDS TO BE DONE AGAIN IN 6 MONTHS Good Shape Sludge buildup on bottom Jim cap missing or a QutStan dpipe to Vabove ground needs repizacing Standpipes Time Floater on top Needs Septictrine Erik Widger From: Dan Hall <DHALL@lynden.com> Sent: Monday, May 18, 2020 5:04 PM To: Erik Widger Cc: Lew Ulmer Subject: Hall's Biocycle System Eric the Biocycle system at my residence located at 15610 Kings Way Drive was installed in 2013. Biocycle Alaska has never had to do any major maintenance to the system and it has been inspected quarterly since install and it has run flawlessly. The leach fields has never frozen or caused any issues in the winter season as well, there has been a variation of winters cold, snowy and always windy but the leach field or system has never had issues with freezing or any other item of concern. Please let me know if I can gather any further info. Thanks Dan Dan Hall ( Knik Construction Co., Inc. Office 249-0283 ( mobile 444-4041 Jeff Garness From: David Harper <dlharper2@gmail.com> Sent: Monday, May 11, 2020 9:06 PM To: Jeff Garness Subject: 15610 Kings Way Drive Jeff, the exposed wire and conduit on the well located at the above address has been corrected as per MOA requirements. David Harper Aarow Pump & Well Service C] 1,'o 9V :,,g NAAVK) ZO//- I bG-IZ-Vt•� (Z -OG) :XO -4C3 1 GGG NV Xe-4j,; OGGS-i�t'E' LOG) :auO4.4 it P-lelvIls PIO oov I i Ag�,,,�ns riouonaGNo� 'CIW 9NI,9Xn5 v/v\i IIV4 NVl :�gt\IMO z Vs-��g # ivld `-17/ 1 IN t�/ I �N fl/ 1�N Z/ I N iijngGv Z -U//- I/ I U:JUN- V4a t4 S d 3NFI *0313 -3-- bulmelp pom Slql uo umous sa(s)w �pnjls mil jo u(-xw,)(jj Gqj dVS38 .R/g ONj C1]CJlAioenSNn 'Wl oi Emiciiing i�G--j-JO iND29=!JIC, V NI DNUICIGD� D,8ni5n,81s qgjaiaoiAi 8iiwo -:moH /g/\�nsIVN19[?70 oi INJnoGgnG :DiON > z NOISIMMS�J.11 VMW JINIO ,Z9-099 3 ,IZ,M69 N 'DRV4 L-�g CR 0-199 3 �6�Xt.69 N -Oaa -711 0 -30 WcienS Nn all :,UIA. za �_Ivcj -3--- 3 3Nn )dmn GV3H 63AO I;T 'Wd K!SO!5 KaZIHS T-,,P'PfPA SUeO\IIPQs IfQH NOGTAA *V G-IJAIV v '5011 -VO I 9A,2ms cngi-4 'NAAOl4G GV !GIX=-4 GiN�tAQIAO'NJAII 9"i iVP I aNV NOJ��gP NMOPG Al�:IJO'J'A 9{-11 Clg�A�ng DAV4 1 iVPi I G 0 ."A WMENIO N v �Il LN U (1) Of 3AV 31MP MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this /Z. Day of 'j'u,�L _ of 20 , by and between > i�uleEhktt,sk ,, herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as ?-Z� ib C. C� located at (legal description) TAN F3W 5tC l f1Z.NEyNE yW-1:L+ 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) _ Throughout the term of this Agreement, thF, Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will in:;pect and make any necessary maintenance, repairs or pennitted alterations to the system. k7ZOwner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 ArOwner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hitreof, or the right of the Municipality thereafter to enforce every provision hereof. S. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt `o amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: ry a -(signati.ire) Date: '2. � ' v_ (print name) STATE OF ALASKA } ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this �7 20'16., by_ 5��✓ NOTARY PUBLIC FOR ALASKA My Commission expires: Mgl 11 la4`1 MUNICIPALITY: By:1 rGZ' (signature) e��,Ca, l 1 t (print name) day of A � , i NOTARY Date: 6 «RC1 1 D Title: (rev. 05/18/2018) Page 3 of Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us ' (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION i, Complete legal description. ~ '~ ]~ Location (Site address or dire~ions) Current Property owner(s) Co lo ~ '-1 Mailing address Expiration Date: ~_~ ..- ,~ Z~.. 0/-./-- Day phone ~ V 5 --' 4) :::5 '7 1 Lending agency Day phone Mailing addreSs Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Well Public Water System · TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto 'and as of the validation d~te shown' below, I verify that my investigation, based on' Procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm I'--'~<t. ~v.~'...~c~.~¢7 "~_~" '- Address ~ ~ /~ ~o~ Engineer's Printed Name ~ ~ ~ ~ DSD SIGNATURE ~ Approved for ~ DisaPproved. Conditional approval for bedrooms. Date ~,-/,t.~---O ~ bedrooms, with tl~e following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Rev. 01~32) X Maintenance Agreements' Sup, plemental Engineeris Report Other · 'Original certificate Date: ~ - ~ q '" 0 ¢ . MuniciPality, of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South.Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ' www.ci.anch'or~ge.ak.us (907) 343-~7904 HEALTH AUTHORITY:AEpROVAL CHECKLIST ~egal Description: ~WELL DATA We, type Date completed Total depth 1~'7 ft. Date of test Static water level Well production If A, B, or C provide PWSID # tVA Sanitary seal (Y/N) y Cased to FROM WELL LOG / ft. ~&t,~ g.p.m. Parcel ID: O~--C)~ ~-tgZ~ Well Log (Y/N) : "-// Wires properly protected (Y/N) '-/ Casing height (above ground) . ,~.'z.,,/..in. AT INSPECTION ft. g.p,m. WATER SAMPLE RESULTS: iColiform colonies/100 mi. Arsenic: mg 'SEPTIC/HOLDING TANK DATA .Tank Type/Material iTanksize /~6~ O gal. Number of Compartments . . Foundation cleanout (Y/N) Date of pumping N Nitrate ~.mgJi. Other bacteria Date of sample: ~IT/'/~Y Collected by: Depression over tank (Y/N) 1'-.1 Pumper ~//A colonies/100 mi. Cleanouts (Y/N) i~-.~ High water alarm (Y/N) ~/ ;ABSORPTION FIELD DATA :Date installed ~ Soil rating (g.p.d./ftz or ft=/13drm) J~) :Length ~.Z7 'Total depth ~-. ~ ft. !Date of adequacy test i Fluid depth in absorption field before test I'J~/-~ in. water added tx' gal, :Elapsed Time: 'C/min. Final fluid depth v'~in. Absorption rate >= !Any rejuvenation treatment (past 12 mo.) (YIN & type) L~ System .type ~O ~/'q ~ ft. Width I C) ft. GraVel below pipe' :~,,' '~ ft. Eft. absorption area ~)-~D ft= Monitoring tube '",/ Depression over field r',.'J NJ~ ,9/_,/ Results (pass/Fail) ~ F;3r. '/ bedrooms New depth If yes, give date g.p.d. D. LIFT STATION , I:' , ', I Date'installed Size in gallons ,"Pump on" level at ~'~ i~i -pump off" level at '~ in.' Datum ~,, ~-t/m,,~ E.' SEPARATION DISTANCES ' ' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic ta[ildlift station on ¢~t AbsorptiOn field on lot i j .,~ ~ , , '- Public sewer main On' adjacent lots On adjacent lots' PUbliC sewer manh°le/cleanout Manhole/Access (Y/N) , j ,.'!i. High water alarm level at' /../~ I' in. Meets alarm & circuit requirements? ' Sewer/s~ptic service linde'i ! o-~ ~L ' Holding tank ~ i/"//A- SEPARATION DISTANCES Fi~OM SEPTIC/HOLDING TANK ON LOT TO: , Building foundation l!i~ Property line I c~ + Absorptio~ field Water main i..4/,~. ! Water service line ., i C;~ Surface w~ater Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD, oN LOT TO: ~ t'--1//~J il~roperty line Water Service Curtain drain FJ COMMENTS Building foundation !: Surface water 1 Wells on adjacent lots: HAA Fee $ Da'ti of Payment i; R, e,cmpt Number Il (Re J: 12/01) Water main" uriveway, parking/vehicle ~torage" t ENGINEER'S CERTIFICATION "~ ': !I ri'certify that I have dete~n~ined ihr°~gh 'field inspecdons~ bno i i~'eview of MuniciiJal rec6}'ds that the 'ab&f/e sYStems are in ~ ~ conformance w/th MOA H~ guidelines m effect on th/s date. 'Engineer's Printe'd Na~ ~ ~ ~b~' ~ ~ ~ ¢.~ l~ Date P-/b -O~ ' ~Waiver Fee $ Date Of Payment iR~cei~t Number Z 3--24--04; 9=lOAM; SGS RefJ/ Client Name Project NameJ# Client Sample ID Matrix 1041315001 Aarow Pump & Well Service 15610 Kings Way 15610 Kings Way Drinking Water PWSID 0 Sample Remarks: ;907 5615301 All Dates/Times are Alaskn Standard Time Printed Date/Time 03/23/2004 10:38 Collected DateJTime 03/17/2004 1 l:O0 Received Date/Time 03/17/2004 15:07 TechnlcnlDirector ~. St pe ~n C. Ede # 2/' 3 Allowable Pv:p Analysis Parameter l~sults PQL Units Method Container ID Limits Date Date Init Waters Department N~-N 1.31 0.100 mg/L EPA 300.0 B (<= 10) 03/18/04 JIB Microbiolog~ Laboratory Total Coliform 0 col]100mL SMI8 922213 A (<=1) 03/17/04 DFr